Fibrinogen-to-albumin ratio independently predicts left ventricular aneurysm in STEMI patients: a retrospective cohort study.

BACKGROUND

Left ventricular aneurysm (LVA) is a severe complication following acute ST-elevation myocardial infarction (STEMI) that worsens prognosis. The fibrinogen-to-albumin ratio (FAR) is an inflammatory biomarker with prognostic value in cardiovascular disease, but its role in predicting LVA remains unclear.

METHODS

We conducted a retrospective cohort study including 1,245 STEMI patients undergoing primary percutaneous coronary intervention (pPCI) at Renmin Hospital of Wuhan University between January 2020 and December 2025. An additional temporally independent cohort of 310 STEMI patients admitted between January 1, 2026 and June 15, 2026 was used for temporal validation. Restricted cubic spline analysis (RCS) was performed to examine the relationship between continuous FAR and LVA risk. Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression were used for variable selection and association analysis. Receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis (DCA), and nomogram were used to develop and validate the prediction model.

RESULTS

In the development cohort, high FAR was independently associated with LVA (OR = 2.10, 95% CI: 1.09-4.04, P = 0.027). The combined model incorporating FAR, left ventricular ejection fraction (LVEF), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) demonstrated high discrimination, with an area under the curve (AUC) of 0.933 (95% CI: 0.914-0.952). In the temporal validation cohort, the combined model retained excellent discriminative performance, with an AUC of 0.934 (95% CI: 0.894-0.974), and showed acceptable calibration, with a mean absolute error of 0.021 after 1,000 bootstrap resamples.

CONCLUSION

Elevated FAR is independently associated with an increased risk of LVA in patients with STEMI following pPCI. Temporal validation further supported the stability of the prediction model in a later patient cohort.